Wednesday, 29 February 2012

Why should there be a focus on children with cancer in resource-limited countries?

This is an often asked question in the context of much of the developing world. And the question should not be surprising; after all neonatal and child mortality from inadequate perinatal care and infectious diseases continue to be the main challenges in these settings. When resources are limited, and needs are many, then often the "less deserving" miss out. Over 5000 children die in India EVERY DAY before they reach the age of 5 years, most of them from prematurity and low birthweight ; neonatal infections; birth asphyxia and birth trauma; pneumonia; and diarrhoeal diseases. In comparison, the total number of children less than 15 years of age with cancer EVERY YEAR in India is around 50,000. So it is not difficult to do the maths and work our areas of focus.

Nevertheless, the life of every child is important and those of us involved in looking after children with cancer in resource-limited settings are well aware of the challenges of access to care, treatment abandonment, etc. The recently published report of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries titled "Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries" is an essential read for all the stakeholders involved in delivering care to children with cancer in developing countries. The global task force is composed of leaders from the cancer and global health communities and is an initiative convened by Harvard Global Equity Initiative, The Harvard Medical School, The Harvard School Of Public Health And The Dana-Farber Cancer Institute.

The report highlights some very important facts which I think are relevant for us

  1. More than 85% of all newly diagnosed children with cancer and 95% of deaths in children with cancer occur in low and middle income countries.
  2. For children aged 5-14, cancer is the third leading cause of death
    in upper-middle, fourth in lower-middle, and eighth in low income countries.
  3. A child diagnosed with cancer who lives in one of the poorest countries has an 80% probability of dying, compared to less than 30% in one of the wealthiest countries

The report identifies a set of candidate cancers and compelling  Cancer Care and Control   opportunities for immediate action to expand prevention and/or treatment. Among these are cancers in children which are ideal targets for advocacy and action in low and middle income countries.


  1. Dear Raman, You elegantly highlight the problem. What we need are innovative solutions. And, I believe, they will need to come from within - indigenously...

    Raghunadharao D

  2. Dear Dr Ramandeep,

    The problem which you are highlighting is like ocean, what we can offer at an individual level is drop in the ocean.

    Simple example is the Govt of Punjab has passed G.O. saying childhood cancer as notifiable disease. This is first of its kind in India.

    These changes at the level of administration, will address this problems better.

    Well "littel drops of water make mighty ocean"

    What I have observed in my clinical expierence, None of my patients parents know what global task force is saying, All they expect is there child should be cured.

    On the other hand beacuse I got DM degree, whom am I to dicide that this child should revceive treatement or not. Is it worth spending money or not "Eg: Stage Neurobalstoma".

    Our work is to treat, and TO DELIVER AT OUR BEST

    Vijay Gandhi L

  3. Dear Dr. Ramandeep Ji,

    I want to know is it possible that we prevent diseases before appearing.
    If we give proper diet and nutrition to patients who are suffering from dangerous diseases, the patient can easily recover.

  4. Dear Pundeer,

    I welcome your question. In principle, avoidance of alcohol and tobacco, dietary modifications and prevention/treatment of certain infections can definitely reduce the occurrence of cancer. However, the role of all of these in children who develop cancer is very small and so "prevention" of childhood cancer is, broadly speaking, not possible.